The Prevalence of Hearing Impairments in Women with Silicone Breast Implants.

Many women with silicone breast implants (SBIs) report non-specific complaints, including hearing impairments. Hearing impairment appears to be associated with a number of autoimmune conditions. The current study aimed to evaluate the prevalence and severity of hearing impairments among women with SBIs and to explore potential improvements in their hearing capability following implant removal. Symptomatic women with SBIs (n = 160) underwent an initial anamnestic interview, and women who reported hearing impairments were selected for the study. These women completed self-report telephone questionnaires regarding their hearing difficulties. Some of these women underwent subjective and objective hearing tests. Out of 159 (50.3%) symptomatic women with SBIs, 80 reported hearing impairments, including hearing loss (44/80; 55%) and tinnitus (45/80; 56.2%). Five out of seven (71.4%) women who underwent an audiologic evaluation exhibited hearing loss. Of women who underwent silicone implant removal, 27 out of 47 (57.4%) reported the improvement or resolution of their hearing complaints. In conclusion, hearing impairment is a frequent complaint among symptomatic women with SBIs, and tinnitus was found to be the most common complaint. A significant reduction in hearing difficulties was observed following silicone implant removal. Further studies using larger populations are needed to verify the occurrence of hearing impairments in these women.

Opening a window into the riddle of misophonia, sensory over-responsiveness, and pain.

Introduction: Misophonia and sensory over-responsiveness (SOR) share physiological and psychological symptoms. While individuals with SOR demonstrate pain perception alterations, these were not explored in misophonia. Methods: This exploratory study comprised thirty healthy adults with (n = 15; based on the Misophonia Questionnaire) and without misophonia. The Sensory Responsiveness Questionnaire (SRQ) was used for evaluating sensory responsiveness. In addition, psychophysical tests were applied for quantification of: (i) stimulus-response function of painful stimuli, (ii) the individual perceived pain intensity, (iii) pain modulation efficiency, (iv) auditory intensity discrimination capability, and (v) painful and unpleasantness responses to six ecological daily sounds using the Battery of Aversiveness to Sounds (BAS). Results: Individuals with misophonia reported higher scores in the SRQ-Aversive (p = 0.022) and SRQ-Hedonic (p = 0.029) scales as well as in auditory (p = 0.042) and smell (p = 0.006) sub-scales, indicating higher sensory responsiveness. Yet they were not identified with the SOR type of sensory modulation dysfunction. Groups did not differ in the pain psychophysical tests, and in auditory discrimination test scores (p > 0.05). However, in the misophonia group the BAS evoked higher pain intensity (p = 0.046) and unpleasantness (p <0.001) ratings in the apple biting sound, and higher unpleasantness rating in the scraping a dish sound (p = 0.007), compared to the comparison group. Conclusion: Findings indicate increased sensory responsiveness in individuals with misophonia, yet not defined as SOR. Thus, this suggests that misophonia and SOR are two distinct conditions, differing in their behavioral responses to painful and non-painful stimuli.

A Clinical Paradigm for Listening Effort Assessment in Middle-Aged Listeners.

Listening effort (LE) has been known to characterize speech recognition in noise regardless of hearing sensitivity and age. Whereas the behavioral measure of dual-task paradigm effectively manifests the cognitive cost that listeners exert when processing speech in background noise, there is no consensus as to a clinical procedure that might best express LE. In order to assess the cognitive load underlying speech recognition in noise and promote counselling for coping strategies, a feasible clinical paradigm is warranted. The ecological validity of such a paradigm might best be demonstrated in middle-aged adults, exhibiting intact hearing sensitivity on one hand, however, experiencing difficulties in degraded listening conditions, unaware of the implicated cognitive cost of speech recognition in noise. To this end, we constructed a dual-task paradigm that consists of a primary task of sentences-in-noise recognition and a secondary task of simple visual colored-shape matching. Research objective was to develop a clinical paradigm for the assessment of LE in middle-aged adults. Participants were 17 middle-aged adults (mean age of 52.81 years) and 23 young adults (mean age of 24.90 years). All participants had normal hearing according to age. Speech stimuli consisted of the Hebrew Matrix sentences in noise test. SRTn was obtained for 80% correct identification. Visual stimuli were colored geometric shapes. Outcome measures were obtained initially for each task separately, to establish performance ability, and then obtained simultaneously. Reaction time and accuracy in the secondary task were the defined metrics for LE. Results: LE was indicated for both groups, however, was more pronounced in the middle-aged, manifested in the visual accuracy and reaction time metrics. Both groups maintained the 80% correct recognition-in-noise in the dual-task, however, the middle-aged group necessitated a better SNR of 1.4dB than the normal hearing group. Moreover, the middle-aged group was taxed in a greater prolongation of reaction time, in order to uphold the correct recognition. Conclusion: a dual-task paradigm consisting of sentences-in-noise primary task combined with a simple secondary task successfully showed different manifestations of LE in middle-aged adults compared to young adults, thus approximating the use of such a paradigm in a clinical setting.

Perceived Sensitivity to Pain and Responsiveness to Non-noxious Sensation in Substance Use Disorder.

OBJECTIVE: This comparative cross-sectional study aimed to characterize individuals with substance use disorder (SUD) in self-perception of pain sensitivity, experimental auditory aversiveness, and non-noxious sensory responsiveness, as well as examine the associations with SUD. METHODS: Therapeutic community (TC) individuals with SUD (N = 63, male 88.9%) and healthy controls (N = 60, male 86.7%) completed the Pain Sensitivity Questionnaire (PSQ) and the Sensory Responsiveness Questionnaire-Intensity Scale (SRQ-IS), followed by a psychophysical auditory battery, the Battery of Averseness to Sounds (BAS)-Revised. RESULTS: The SUD group scored higher on the PSQ (P < 0.0001), BAS-R aversiveness (P < 0.0001), BAS-R-unpleasantness (P < 0.0001), and on the aftersensation of auditory aversiveness (P < 0.0001) and unpleasantness (P < 0.000). Fifty-four percent of the SUD group vs 11.7% of the control group were identified as having sensory modulation dysfunction (SMD; P < 0.0001). Logistic regression modeling revealed that the SRQ-IS-Aversive score had a stronger relationship, indicating a 12.6-times odds ratio for SUD (P = 0.0002). Finally, a risk score calculated from a linear combination of the logistic regression model parameters is presented based on the PSQ and SRQ. CONCLUSIONS: This is the first study to explore sensory and aversive domains using experimental and self-reporting in situ, revealing pain perception alteration that co-occurs with high prevalence of SMD, specifically of the over-responsive type. Findings may be significant in clinical practice for treating pain, and for expanding therapeutic modalities as part of broader rehabilitation in TC and beyond, to better meet personalized therapy.

Listening to music with personal listening devices: monitoring the noise dose using a smartphone application.

OBJECTIVES: To monitor listening habits to personal listening devices (PLDs) using a smartphone application and to compare actual listening habits to self-report data. DESIGN: Two stages: self-report listening habits questionnaire, and real-time monitoring of listening habits through a smartphone application. STUDY SAMPLE: Overall 117 participants aged 18-34 years (mean 25.5 years) completed the questionnaire, and of them, 40 participants (mean age: 25.2 years) were monitored for listening habits during two weeks. RESULTS: Questionnaire main findings indicated that most of the participants reported listening for 4-7 days a week, for at least 30 min at high listening levels with volume control settings at 75-100%. Monitored data showed that actual listening days per week were 1.5-6.5 d, with mean continuous time of 1.56 h, and mean volume control setting of 7.39 (on a scale of 1-15). Eight participants (22%) were found to exceed the 100% noise dose at least once during the monitoring period. One participant (2.7%) exceeded the weekly 100% daily noise dose. Correlations between actual measurements and self-report data were low to moderate. CONCLUSIONS: Results confirmed the feasibility of monitoring listening habits by a smartphone application, and underscore the need for such a tool to enable safe listening behaviour.

Evidence for a right cochlear implant advantage in simultaneous bilateral cochlear implantation.

OBJECTIVES/HYPOTHESIS: To compare speech perception performance with right versus left cochlear implants (CIs) in children with bilateral CIs implanted simultaneously. STUDY DESIGN: Prospective case series of patients undergoing simultaneous bilateral cochlear implantation. METHODS: Speech perception performance was tested in 10, right-handed children who received bilateral CIs simultaneously between 11 and 36 months (mean, 21 months), had at least 18 months of bilateral CI use, and were 5.3 years of age during testing. All children exhibited bilateral symmetrical severe-to-profound hearing loss prior to implantation and did not benefit from hearing aids. Speech perception performance was evaluated with the right CI and the left CI by means of an open-set monosyllabic word test in quiet presented at 45 dB HL in a sound field. RESULTS: All children exhibited higher performance with the right CI compared to the left CI. Group mean performance with the right CI was 66.5% compared to 52% with the left CI (P = .002), yielding a 14.5% difference. With increasing duration of bilateral CI use and age at evaluation, the right-left difference increased (r = 0.72, P = .019 and r = 0.74, P = .014, respectively). CONCLUSIONS: Current preliminary data indicate that children with bilateral CIs implanted simultaneously exhibit a significant right ear advantage for speech. Similarly to reports on normal-hearing children, right ear preference for speech increased with increasing age and auditory-linguistic experience. Thus, simultaneous bilateral cochlear implantation may lead to normal development of auditory pathways and may be an important contributor to the superior auditory, language, and communication skills reported in children with bilateral versus unilateral CIs.

Hearing aid satisfaction and use in the advanced digital era.

OBJECTIVES/HYPOTHESIS: To evaluate satisfaction ratings and use patterns of advanced digital hearing aids (HAs) in a group of hearing-impaired adults by means of self-report questionnaires. STUDY DESIGN: A self report questionnaire study. METHODS: One hundred seventy-seven hearing-impaired adults who were fitted with advanced digital HAs at the Speech and Hearing Center at Sheba Medical Center were asked to participate in a structured telephone interview regarding HA satisfaction and use by means of the Satisfaction With Amplification in Daily Life (SADL) questionnaire. Patients who were not using their HAs completed a nonuse questionnaire. RESULTS: One hundred thirty-one patients participated in the survey, yielding a response rate of 74%. Eighty-three percent used their HAs regularly, whereas 17% were nonusers. Of the users, 92% were satisfied to some degree with their HAs. The global SADL score was 5.12 on a scale of 1 to 7. Background variables that were significantly associated with satisfaction ratings were hours of HA use per day, fitting mode (binaural vs. monaural), age, and degree of hearing loss. Although nonuse was not significantly associated with background variables, the main reasons for nonuse were excessive amplification in background noise and minimal functional benefit. CONCLUSIONS: High satisfaction and use rates were characteristic of adults fitted with advanced digital HAs. Patients should be advised that longer use of HAs per day may lead to higher satisfaction and that binaural amplification is advantageous, especially while communicating in noise. Finally, expectation from HA functionality in challenging listening situations should be realistic, as additional research and technology development is still needed.

Preferred listening levels of personal listening devices in young teenagers: self reports and physical measurements.

OBJECTIVE: To assess the potential risk of hearing loss to young listeners, due to the use of personal listening devices (PLDs). DESIGN: The study included two parts: (1) A self-report questionnaire on music listening habits, and (2) Physical measurements of preferred listening levels, in quiet and in everyday background noise. STUDY SAMPLE: Young teenagers aged 13 to 17 years. Part 1 included 289 participants with mean age of 14 years. Part 2 included 11 and 74 participants (2A and 2B) with a mean age of 15 years. Eleven listened to PLDs in quiet conditions (2A) and 74 in everyday background noise (2B). RESULTS: Questionnaire main findings indicated that most of the participants reported high or very high volume settings and demonstrated low awareness towards loud music listening consequences. Physical measurements corrected for diffuse field indicated mean preferred listening levels of: 82 (SD = 9) dBA in quiet, and 89 (SD = 9) dBA in the presence of background noise. The potential risk to hearing of PLDs users was calculated using the 8 hour equivalent level. CONCLUSION: More than 25% of the participants in the noisy condition were found to be at risk according to occupational damage risk criteria NIOSH, 1998.

Cochlear implant recipients' hearing sensation as manifested by their maps during pregnancy and postpartum.

OBJECTIVE: To investigate possible changes in hearing sensation as manifested in the maps' psychoacoustic parameters, threshold (T), and most comfortable (C/M) levels among cochlear implant (CI) female recipients during pregnancy and after delivery. SETTING: University-affiliated tertiary referral center. DESIGN: : Retrospective study. METHOD: Two MedEl device and 3 Nucleus device users' medical records were reviewed for age at the time of implantation, cause of deafness, type of anesthesia used during delivery, and maps' parameters (T and C/M levels) during pregnancy and after childbirth. RESULTS: Two CI recipients underwent uncomplicated cesarean deliveries under spinal anesthesia, and 3 others had natural delivery without anesthesia. There were no changes in map values during pregnancy, delivery, and the postpartum period in 4 of 5 CI recipients. Only 1 CI recipient showed significant increase in T levels that was resolved after she completed breastfeeding 3 months postdelivery. CONCLUSION: The elevation in T levels might indicate that pregnancy and delivery can result in some temporary reversible changes in hearing sensation manifested by map levels of CI users.

Identification of syllables in noise: electrophysiological and behavioral correlates.

This study was designed to characterize the effect of background noise on the identification of syllables using behavioral and electrophysiological measures. Twenty normal-hearing adults (18-30 years) performed an identification task in a two-alternative forced-choice paradigm. Stimuli consisted of naturally produced syllables [da] and [ga] embedded in white noise. The noise was initiated 1000 ms before the onset of the speech stimuli in order to separate the auditory event related potentials (AERP) response to noise onset from that to the speech. Syllables were presented in quiet and in five SNRs: +15, +3, 0, -3, and -6 dB. Results show that (1) performance accuracy, d', and reaction time were affected by the noise, more so for reaction time; (2) both N1 and P3 latency were prolonged as noise levels increased, more so for P3; (3) [ga] was better identified than [da], in all noise conditions; and (4) P3 latency was longer for [da] than for [ga] for SNR 0 through -6 dB, while N1 latency was longer for [ga] than for [da] in most listening conditions. In conclusion, the unique stimuli structure utilized in this study demonstrated the effects of noise on speech recognition at both the physical and the perceptual processing levels.

A longitudinal study of electrical stimulation levels and electrode impedance in children using the Clarion cochlear implant.

CONCLUSIONS: Electrical stimulation levels and electrode impedance values (EIVs) in children using the Clarion cochlear implant (CI) programmed with CIS strategy stabilized after 3 months of implant use. The data presented here may be useful as a general guideline for the programming of infants and young children and may further be of help for the identification of patients who fall outside the "average" range. OBJECTIVES: The purpose of the present study was to evaluate changes in electrical stimulation levels, i.e. threshold (T) levels, comfortable (M) levels, dynamic range (DR), and EIVs during the first 18 months of implant use, in children using the Clarion CI. MATERIALS AND METHODS: The maps of 18 pre-lingual children (mean age at implantation 4.2 years; range 1-8), using the Enhanced Bipolar 1.2 or Bipolar standard electrode with the S-Series speech processor programmed with CIS strategy, were examined at five time points: connection, and 3, 6, 12, and 18 months post-initial stimulation. T levels, M levels, DR and EIVs were analyzed according to four cochlear segments: apical, apical-medial, medial-basal, and basal. RESULTS: During the first 3 months of implant use T levels increased to some extent, whereas M levels and DR increased significantly. From 3 months and through the entire follow-up, T and M levels as well as DR were stable. EIVs of current carrying electrodes decreased significantly from connection to the 3-month visit; thereafter a stabilization of values was evident. Electrical stimulation levels and EIVs did not differ among the cochlear segments during the entire follow-up.

Acute otitis media and mastoiditis following cochlear implantation.

OBJECTIVE: To examine the incidence of acute otitis media (AOM) and mastoiditis in children after cochlear implantation (CI) and to evaluate the role of mastoidectomy in decreasing the rate of AOM in implanted children by comparing two surgical techniques: the Posterior tympanotomy approach (MPTA, with mastoidectomy) and the Suprameatal approach (SMA, without mastoidectomy). METHODS: A retrospective study was conducted on 234 children up to 16 years of age who underwent CI between 1993 and 2003 in our department. The children were divided into two groups according to the surgical technique that had been used for the implantation: the MPTA group and the SMA group. RESULTS: Part of the children with a history of pre-implantation AOM (22 of 29 in MPTA group and 26 of 38 in SMA group) did not suffer from AOM post-CI (p=0.59), and an incidence of AOM after CI in children who did not have history of AOM prior to implantation (13 patients of MPTA group and 15 patients of SMA group) was unrelated to surgical approach (p=0.65). The incidence of pre-implantation AOM was similar for the two groups and declined after CI unrelated to performing of mastoidectomy in surgical technique. Overall, 47 children (20.1%) had post-CI AOM compared to 67 children (28.6%) who had pre-CI AOM. Mastoiditis developed in 11 children (4.7%), all 11 in the MPTA group. A subperiosteal abscess was incised and drained with the retroauricular approach in three of these children and the others were managed with intravenously administered ceftriaxone 50mg/kg/day for 3-5 consecutive days, followed by a course of oral cephalexin until there is complete clinical resolution of the effusion in the middle ear. The implants were preserved in all cases. Seven out of 11 children with mastoiditis had no history of AOM prior to implantation. CONCLUSIONS: AOM and mastoiditis represent common complications of CI that can be successfully treated with the prompt use of antibiotics. However, the subperiosteal abscess could require surgical drainage. In our opinion, the decrease of incidence of AOM in implanted children is the result of natural history of otitis media and is unrelated to the surgical approach.

Surgical and medical complications in paediatric cochlear implantation: a review of 300 cases.

The aim of the study was to investigate an incidence of surgical and medical complications in different age groups of cochlear implant children. A retrospective study design was used. Patients' medical records were reviewed for age at the time of implantation, cause of deafness and complications. The incidence of complications was compared between the young (aged up to 2 years, n = 61) and older children (aged 216 years, n = 239). Some 300 paediatric cochlear implantations were performed in our department between January 1993 and March 2005. Major complications, such as facial nerve paralysis, electrode misplacement, foreign body reaction, flap breakdown, protrusion of the positioner and cholesteatoma were rare (3%). Disequilibrium was found to be the most common complication, followed by wound problems and mastoiditis without significant differences between the two groups. However, magnet or receiver-stimulator displacement were more common in the young children (p = 0.028). Most surgical and medical complications could be treated successfully, and only 2% required explantation of the device. Generally, operating on a child aged under 2 years was not particularly different from operating on an older child.

Electrical stimulation levels and electrode impedance values in children using the Med-El Combi 40+ cochlear implant: a one year follow-up.

The present study was designed to follow changes in electrical stimulation levels and electrode impedance values (EIV) in children using the Med-El Combi 40+ cochlear implant (CI) during the first 12 months of implant use. The maps of 24 prelingually deaf children implanted at a mean age of 5.9 years (range 1-15.9 years) using the TEMPO+ speech processor programmed with CIS+ strategy were examined at five time points: initial stimulation, and 1, 3, 6, and 12 months post-initial stimulation. Most comfortable levels (M) and electrode impedance values (EIV) were analyzed according to three cochlear segments: apical, medial, and basal. Results indicated a significant increase in M levels until the 3-month time point, thereafter stabilization was evident. Furthermore, M levels in the apical segment were lower than those in the medial and basal segments. EIV decreased from initial stimulation to the 3-month time point and was then stable through the study follow up. Interestingly, the finding of higher EIV in the apical segment may be attributed to the physical characteristics of the Med-El electrode. In conclusion, the pattern of stabilization of M levels found in the present study is similar to that reported for children using other devices. The data presented here may be useful as a guideline for programming M levels and monitoring EIV in infants and young children. They may further help clinicians to identify those children that fall outside the 'typical' range.

Speech perception of children using Nucleus, Clarion or Med-El cochlear implants.

OBJECTIVE: The purpose of this study was to present speech perception achievements of implanted children using commercially available cochlear implant devices: Nucleus, Clarion or Med-El. STUDY DESIGN: A retrospective analysis. METHODS: Speech perception data of 96 hearing-impaired children: 27 with Clarion, 49 with Nucleus and 20 with Med-El were collected. Speech tests included the Hebrew Infant Toddlers Meaningful Auditory Integration Scale (HIT-MAIS) for the infants, the Hebrew Early Speech Perception (HESP) closed-set word-identification test and Hebrew Arthur Boothroyd (HAB) open-set one-syllable word recognition test were used for the older children. RESULTS: I HIT-MAIS: (1) Infants showed similar rate of progress, regardless of device. (2) Children implanted under two years of age reached performance within normal development on this test. II HAB: (1) Most children achieved open set results with mean HAB between 40 and 50%, within 1-1.5 years post implantation. (2) Linear regression analyses revealed no statistical differences between the Clarion the Nucleus and the Med-El devices on the mean final measurement of this test. (3) Age of implantation and mode of communication were significant covariate variables: (a) the younger the child is implanted the better the results and (b) oral communication prior to implantation results in better performance than sign language. CONCLUSIONS: There are no apparent differences in speech perception performance between implant devices when considering background variables. The data have important implications on the rehabilitation process of hearing impaired children with cochlear implants in relation to device selection, age at implantation and mode of communication prior to implantation.

NRT-based versus behavioral-based MAP: a comparison of parameters and speech perception in young children.

The present study was designed to evaluate the effect of neural response telemetry (NRT)-based cochlear implant (CI) programming versus behavioral-based programming on electrical stimulation parameters (MAP) threshold (T) and comfortable (C) levels and speech perception abilities in young children, during the first year of implant use. Ten congenitally deaf children at the age of 12-39 months (mean age: 25.2 months) implanted with the Nucleus 24R(CS) CI participated in the study. The group was randomly divided into two: (1) NRT-based MAP group (n = 5) consisted of children who were programmed using intra-operative NRT measurements; (2) behavioral-based MAP group (n = 5) consisted of children who were programmed using the behavioral responses of the patients. MAP parameters as well as sound-field aided thresholds and speech perception abilities were compared between the two groups at consecutive programming sessions: 1, 3, 6, and 12 months post initial stimulation. Results indicated no significant differences among NRT-based MAPs and behavioral-based MAPs. Although MAP profiles at initial stimulation differed in the apical region, these differences decreased with time. In addition, a gradual increase of T and C levels of NRT-based MAPs as well as those of behavioral-based MAPs was evident until the 1-month time point, thereafter stabilization occurred. Sound-field aided thresholds improved with time for both groups; however, they were found to be significantly better for the NRT-based MAP group. Despite these differences, speech perception abilities were comparable among groups at 12 months post initial stimulation. NRT-based programming was found to be significantly shorter than behavioral-based programming. In conclusion, for this small group of children, our findings support the use of NRT for programming of young children during the initial period after implantation.

Changes over time in the psycho-electric parameters in children with cochlear implants.

Information regarding typical changes in electrical stimulation levels during different stages post-implantation in children is scarce. Clinically, this information can serve as a general guideline to the nature and frequency of these changes, and consequently help to determine programming schedules that would optimize performance with the implant. Furthermore, it may have implications for the design of cochlear implants, and for monitoring the condition of the implanted cochlea. The main goal of the present study was, therefore, to evaluate changes over time in psycho-electric parameters, i.e. threshold levels, comfortable levels, and dynamic range, in children with the Nucleus 22 cochlear implant system. The maps of 37 prelingual children were examined at five time intervals: 1, 6, 12, 18 and 24 months post-connection. Maps were analyzed according to three cochlear segments: basal, medial, and apical. The results indicated significant changes in the psycho-electric parameters during the first 2 years post-implantation. Specifically, threshold (T) levels increased significantly during the first year and stabilized during the second year, whereas comfort (C) levels and dynamic range (DR) increased significantly during the entire 2-year follow-up. In addition, psycho-electric parameters varied among the different cochlear segments, resulting in a narrower DR in the basal one. Regardless of the underlying cause for these changes, the results of the present study suggest that, in children, the stabilization of psycho-electric parameters is a prolonged, gradual process. Since psycho-electric parameters play an important role in speech perception, these findings emphasize the need for frequent programming in the first 2 years of implant use in children.

Changes over time in electrical stimulation levels and electrode impedance values in children using the Nucleus 24M cochlear implant.

OBJECTIVE: The present study was designed to evaluate changes in psycho-electric parameters, i.e. threshold levels, comfortable levels, dynamic range, and electrode impedance values during the 1st year post-implantation, in children using the Nucleus 24M cochlear implant system. METHODS: The maps of 25 pre-lingual children programmed with ACE strategy in Monopolar 1 + 2 mode were examined at five time points: connection, 1, 3, 6, and 12 months post-initial stimulation. Maps and electrode impedance values were analyzed according to three cochlear segments: basal, medial, and apical. RESULTS: Significant elevations of thresholds, comfortable levels, and dynamic range were found during the first few months of implant use. Specifically, threshold increased and dynamic range widened until the 3 months visit, whereas comfortable levels continued to increase until the 6 months visit, thereafter levels stabilized. Electrode impedance values decreased significantly from connection to the 1-month visit thereafter a stabilization of values was evident. In addition, thresholds and comfortable levels were found to be significantly lower in the apical segment, whereas dynamic range and electrode impedance values did not differ among the cochlear segments. CONCLUSIONS: Significant changes in psycho-electric parameters and electrode impedance values were evident during the first 6 months of implant use. Given the important role of an optimal map for speech perception, frequent programming sessions during the first few months of implant use are essential.